Ebola Impact in an Uninfected Country

As Guinea and Sierra Leone struggle to eliminate Ebola within their borders, Liberia finally reached the milestone of 42 days without any new cases. The world continues to scrutinize the warning signs from a year ago hinting at the exploding outbreak; it is highlighting all of the flaws in preparedness from leading health organizations. What isn’t being analyzed is repercussions from Ebola so far flung, they haven’t been discussed.

Have you heard about what effects Ebola had in Rwanda? No cases have ever been diagnosed or treated within their borders, yet the outbreak caused changes in health strategy and preparedness as well as resource scarcity.

Paul Farmer preached staff, stuff, space, and systems as the key ingredients to addressing the Ebola outbreak in West Africa. With this battle cry, he directed Partners In Health (PIH) resources to the region in September 2014. As a PIH Rwanda employee, I championed this mission and fully supported our organization taking our health systems strengthening mentality to an area in need of assistance. However, this quick expansion of the PIH workload, immediately impacted the work in Rwanda.


The Boston office supports all PIH sites. With the start of Ebola response, no new staff were immediately hired. Thus, the current staff doubled their workload taking on opening an entirely new operation in a new country. This led a very self-sufficient PIH site in Rwanda, to receive less assistance from the headquarters and some work to get delayed.


International procurement requests, including most chemotherapy used at the Butaro Cancer Center of Excellence and non-communicable disease medications, are facilitated by the Boston team. In September, Rwanda placed their bulk order requests for the next 12 months supply of medicine; this coincided with the opening of the West African PIH sites. The procurement team now needed to support Ebola response and making sure that all of the personal protective equipment and lifesaving IV fluids were reaching those who needed them. The unintended delays in procuring medicines for Rwanda led to our team having to place emergency orders to quickly requisition those medicines that were nearing stock out levels due to delays in the bulk order. Additionally, suppliers caused the delays in medicine reaching Rwanda as several experienced shortages of highly needed products since they were sending as much as possible to West Africa. After the initial transition period with new staff hires, PIH once again has staff specifically assigned to helping Rwanda obtain the stuff they need in a timely manner.


Space was not something Ebola could impact in Rwandan sites, since we didn’t see any actual Ebola cases. In fact, at PIH Rwanda, sites in particular new buildings are being constructed to expand the hospitals patient capacity. In Butaro, the infusion center has opened to allow for chemotherapy to be administered to outpatients. In Rwinkwavu, a new administration building is being constructed so that the old space can be used to expand the ward. In Kirehe, phase three of hospital construction is nearing completion.


The Ebola outbreak emphasized how the Ministry of Health in Rwanda can be active and prepared for the worst.  It didn’t take long for the Ministry to send personal protective equipment to all hospitals and health centers. I noticed signs posted on the walls describing how to protect oneself and prevent transmission on every health center site visit I took. Everyone entering Rwanda, whether by land or air, has their temperature read by a laser thermometer. Those flying in fill out health forms detailing their current health and prior travel. Partners In Health conducted staff training on how to be prepared. The health system was prepared to handle a potential threat in country. This is what was lacking in Sierra Leone and Liberia that PIH hopes to help their Ministries build, a system that can take on any challenge and health threat.

As we now stand, nine months after the Sierra Leone and Liberia projects began, Rwanda continues to function as it did before the outbreak. We have all of the staff, stuff, space, and systems needed to continue to operate at our full potential. I think the short term consequences of organizational growth takes time to overcome, but the end result is PIH running two successful functioning programs where there was once only one.